Posted by: notdeaddinosaur | September 1, 2014

Those to Whom the Rules Do Not Apply (In Their Opinion)

There’s a patient I don’t like very much. I’ll call her Mrs. X.

Mrs. X has definite medical problems, though she doesn’t seem to think so. Her lipids and blood pressure really are much higher than they should be. She could stand to lose a couple of pounds, and she really should be more active. She does not concur.

Every time she makes an appointment, she calls and changes it three, four, five times. After all that, she often doesn’t show up.

The first time I saw her, I identified several health issues. I told her that her blood pressure was too high, as was her cholesterol.

Her response: “I disagree.”

Say what?

“I don’t really think I have much of a problem. I’ll see if I can do something about the way I eat, but I’m not really worried.”

That made one of us. The BP was 190/114, with fasting triglycerides over 700. Her liver function tests were also abnormal (no surprise with TGs that high), so I asked her to get an ultrasound of her liver.

“I don’t think that’s necessary.”

Okay then.

She agreed to begin a medication, for which I asked her to return in three months for a blood test. She took the prescription, and vanished for a year and a half. After a while, I got a notice from the pharmacy that she was requesting a refill. I refused, telling them to ask her to call for an appointment. Six months later, she did. Then she re-scheduled it three times, no-showed once, called again, and finally came in…late.

Without exaggeration, I can say this patient has repeated this cycle at least three times since I’ve known her.

Make no mistake: I have plenty of patients who are reluctant to take my advice about their health. I’m not even quite sure what it is about this person that rubs me the wrong way.

Why does she expect me to continue calling in prescriptions without seeing her to monitor them? It’s as if she doesn’t seem to feel that the rules for everyone else (coming to appointments on time, for example) should apply to her.

As I say, I don’t quite understand why this particular patient has this effect on me. Suffice it to say that I cringe a little whenever I see her name on the schedule. Then I reassure myself that she probably won’t show up, and two out of three times I’m right. But when she does, I know it’s going to be a frustrating encounter.

Is there anything I can do? Firing her is an option, though a bit of an over-reaction as I don’t really have grounds for something that extreme. Stop prescribing without visits? I have, though I fear for her health.

I guess I’ll just keep on muddling through.

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Responses

  1. funny!

  2. I’m not a doctor, but I’d suggest she find one she trusts enough to take their advice. All she’s doing is wasting both of your time.

  3. Accept the things you cannot change… Perhaps try to schedule a patient close behind her. When she’s late,take the other patient first and make her wait. Always, make her WAIT! Her health is her problem not yours, but document,document…. Lu, m

    >

  4. My father was the same. I often why he bothered wasting anyone’s time.

  5. Firing her is in no way an over-reaction, and you should do it ASAP. She has no respect for your opinions or your time. The repeated no-shows alone are ample justification for terminating the relationship.

  6. I am not a medical professional here, but I have degrees in psychology … Denial is powerful. Some people think if they deny they have any medical problems, then they won’t get sick and die. Have you asked her what she wants from you, what her health goals are, and whether she trusts you or any other doctor to help her reach those goals? If she were my patient and she *admitted* she didn’t trust me, I would say, “Then I’m the wrong doctor for you. Perhaps this should be our last visit.” Then I would see what she says. Maybe she’ll get mad and leave, and then she’ll be someone else’s problem. Maybe she will confess to being worried about some symptom she hasn’t mentioned to you. Or maybe she will profess that she does trust you. My response to that would be, “If you trust me, why do you think I would lie and tell you that the lab results indicate serious problems? Do you think I am a liar?” It might make an interesting conversation!

  7. What Robert said. You’ve already gone above and beyond the call here. She is wasting your time and hers not to mention insurance money. This has been going on long enough. And make no mistake, when she finally gets a major issue she’s going to try to make it YOUR FAULT. A discharge letter is way overdue.

  8. We can only give advice to patients and of course we can’t make them do anything but we can and should expect them to treat us as we treat them with common courtesy and respect. She is not respecting your rules or your time. A frank discussion as Elle suggested may be helpful but tell her that it’s her last chance to stay in the practice. I have a “3 strike rule” for no shows, rude behavior and last minute cancellations. You sound very kind and with the doctor shortage there are probably a 100 patients willing to get better who you can help in her place. Glad you have a place to rant. 🙂 Tracey

  9. Make sure the chart documents all the no-shows she’s had. Document that you warned her about stroke, heart attack, kidney failure and fatty liver disease…

    Then fire her for non-compliance. This lady is nothing but a liability.

  10. Charge for missed appointments or cancellation within 24 hours of an appointment.


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